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NEUROSURGICAL ANESTHESIA

The Acute Cerebrovascular Effects of Intracarotid Adenosine in Nonhuman Primates

Shailendra Joshi, MD^*, Roger Hartl, MD, Mei Wang, MS^*, Lei Feng, MD, Daniel Hoh, BA, Robert R. Sciacca, EngScD^||, and Sundeep Mangla, MD

Departments of *Anesthesiology, Radiology, Neurological Surgery, and ||Medicine, College of Physicians and Surgeons of Columbia University, New York, New York; and Department of Neurosurgery, Weill Medical College, Cornell University, New York, New York

Address correspondence to Shailendra Joshi, MD, Department of Anesthesiology, P&S Box 46, College of Physicians and Surgeons of Columbia University, 630 W. 168th St., New York, NY 10032. Address e-mail to sj121{at}columbia.edu No reprints will be available.

In this study we sought to determine the acute cerebrovascular effects of intracarotid adenosine by using real-time cerebral blood flow (CBF) measurements in nonhuman primates. The internal carotid arteries of healthy anesthetized baboons were transfemorally cannulated. Changes in CBF were continuously measured at baseline and with 6 increasing doses of adenosine (0.002 to 1.5 mg/min) by use of an intraparenchymal thermal diffusion (TD) probe. Each infusion lasted 5 min. At baseline and at the largest dose of adenosine, CBF was also determined by the intraarterial ¹³³Xe technique. TD measurements revealed a dose-dependent increase in CBF from 32 ± 6 mL · l00 g^-1 · min^-1 at baseline to 90 ± 38 mL · l00 g^-1 · min^-1 with the largest dose of adenosine (n = 5; P < 0.0001). A similar magnitude of increase in CBF was also observed with ¹³³Xe CBF measurements. No significant increases in intracranial pressure or adverse systemic hemodynamic side effects were observed during adenosine infusion. The increase in CBF after adenosine lasted only for the duration of drug infusion. In conclusion, the transient cerebrovascular effects of intracarotid adenosine make it suitable for a trial of intraarterial vasodilator therapy and for controlled manipulation of cerebrovascular resistance.

IMPLICATIONS: Using a real-time cerebral blood flow (CBF) measurement technique, we evaluated the acute cerebrovascular effects of intracarotid adenosine in anesthetized baboons. The increase in CBF lasted only for the duration of the adenosine infusion. Adenosine might be a suitable drug for trial as an intraarterial vasodilator for the treatment of cerebral vasospasm.